Getting health care in Greg Abbott’s Texas—it’s like winning the raffle

Contact: Alexis.Torres@mail.house.gov

Washington, D.C.—In a surprising new email obtained by Representative Lloyd Doggett (D-Austin), Governor Greg Abbott’s Texas Health and Human Services Commission (HHSC) offers only a raffle and “6 Days of Merry Service” to resolve the growing backlog in Medicaid and SNAP applications. Beginning today, an overburdened and demoralized workforce must complete 15 hours of overtime in six days to be entered into a raffle, on top of an already mandated monthly 20 hours of overtime required during the past three years. Today, Rep. Doggett is again urging Centers for Medicaid & Medicare Services (CMS) Administrator Chiquita Brooks-LaSure to fulfill federal enforcement responsibilities and require a comprehensive corrective action plan from Texas HHSC, implemented under federal supervision, to ensure timely assistance to Texans in need.

“Disadvantaged Texans shouldn’t have to win a raffle to secure needed health care, and going hungry is hardly ‘Merry.’ Thousands of Texas children, seniors, the disabled, and others are the victims of two wrongs: Governor Greg Abbott’s Administration’s blatant violation of federal Medicaid rules, and CMS failure to use its oversight authority to protect them,” said Rep. Doggett. “Refusing to put in place the leadership and workforce capable of delivering the services Texans deserve, the Abbott Administration offers a raffle rather than a solution. It continues with a failed and unsustainable approach, which it admits will not ultimately result in compliance with federal law. CMS must act now or share the responsibility for the neglect of so many vulnerable Texans.”

In August, the entire Texas Congressional Democratic delegation called on CMS to intervene and pause the State’s Medicaid redetermination process as well as take corrective action. After receiving more whistleblower reports from Texas HHSC staff detailing continued failures, Rep. Doggett followed up with CMS in September urging a comprehensive audit. Similarly, in September, Rep. Doggett and the Texas Democratic Congressional delegation urged the U.S. Department of Agriculture (USDA) to require a corrective action plan to address backlogs in SNAP food assistance. The USDA is now working with Texas to strengthen and finalize a corrective action plan on SNAP.

Rep. Doggett’s most recent letter in full can be read below and viewed here. The email to Texas HHSC employees can be viewed here.

Dear Administrator Brooks-LaSure:

I write again to urge CMS to fulfill its responsibility to enforce federal law regarding the State of Texas’s violation of federal Medicaid rules and obstruction of health care access.  The CMS response to concerns raised by me and my colleagues has been woefully inadequate.  Meaningful action has not been undertaken to hold the Abbott Administration accountable.  To date, 1.4 million Texans, mostly children, have been denied access to a family physician as the Medicaid redeterminations process continues.  New Medicaid applications are left sitting for months with no final determination.  You should require the Abbott Administration to submit a corrective action plan to promptly come into compliance with federal timely processing requirements and follow up with careful CMS monitoring and enforcement.

As you are well aware, federal rules require disability-related Medicaid applications to be processed within 90 days and all other Medicaid applications to be completed within 45 days.  In August, you reiterated these requirements to all State Medicaid Directors and gave notice that states out of compliance “may be requested to submit a corrective action plan.”  At the time of your letter, one in six modified adjusted gross income (MAGI) application determinations took more than 45 days, and the crisis worsened to one in five applications.  By October, one in three Medicaid applications that received final determinations had been pending for more than 45 days.  The lead time for an eligibility worker to even begin processing an application is now 120 days.  Yet inexplicably, CMS has failed to take any effective action.

As of November, 50,000 Texans who applied prior to April 1 still await health care over seven months later.  The full scope of the backlog is unknown as applications submitted after April 1 have not been included in publicly reported data.  Many of these new applications are likely Texans who are eligible for help, but recently lost their health coverage due to the State’s own Medicaid redetermination procedural failures.

Despite having its largest budget surplus in State history, including substantial federal dollars, Texas has refused to address these backlogs and meet federal requirements.  Instead of hiring a regular workforce sufficient to comply with federal law, the State has demanded 20 hours a month in mandatory overtime since October 2020.  Now, the enclosed email shows the State is merely offering a raffle to entice an overburdened and demoralized workforce to put in a few more hours.  A raffle can hardly hope to achieve what three years of mandatory overtime could not.  And even if this modest effort works a miracle, the State’s best case plan still does not comply with Medicaid requirements.  Without federal intervention, the Abbott Administration will leave thousands of Texans awaiting health care for months longer than federal rules permit.

Similar backlogs and delays from the same State agency are occurring with food assistance applications as thousands of Texans await SNAP benefits, some for over six months.  At my urging, the U.S. Department of Agriculture (USDA) has rightfully stepped in and engaged the State in corrective action proceedings.  Though the State’s current SNAP proposal is woefully deficient, USDA has at least done what CMS has refused by sending federal officials to Texas to observe the situation and offer technical assistance.  A few phone calls will not resolve these severe deficiencies.  Please don’t continue to be intimidated by Texas; don’t join the Abbott Administration in bearing responsibility for the mistreatment of so many disadvantaged Texans who need Medicaid to access a family physician.

Please act immediately and require a comprehensive corrective action plan that ensures the timely processing of Medicaid applications.  Each day of delay causes further harm to the most vulnerable and marginalized Texans, most of whom are children and communities of color.  I stand ready to work with you, the State of Texas, and any willing partner to promote health equity and protect health care access.